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J Neurol Surg B Skull Base 2019; 80(06): 626-631
DOI: 10.1055/s-0039-1677677
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Improved Surgical Safety via Intraoperative Navigation for Transnasal Transsphenoidal Resection of Pituitary Adenomas

Rebecca L. Achey
1   Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States
,
Michael Karsy
2   Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
Mohammed A. Azab
2   Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
Jonathan Scoville
2   Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
Bornali Kundu
2   Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
,
Christian A. Bowers
3   Department of Neurosurgery, New York Medical College, Valhalla, New York, United States
,
William T. Couldwell
2   Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Further Information

Publication History

28 June 2018

15 December 2018

Publication Date:
21 January 2019 (online)

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Abstract

Objectives Intraoperative navigation during neurosurgery can aid in the detection of critical structures and target lesions. The safety and efficacy of intraoperative, stereotactic computed tomography (CT) in the transnasal transsphenoidal resection of pituitary adenomas were explored.

Design Retrospective chart review

Setting Tertiary care hospital

Participants Patients who underwent transsphenoidal resection of pituitary adenomas from February 2002 to May 2017. Intraoperative stereotactic CT navigation was used for all patients after mid-October 2013.

Main Outcome Measures Operative time, estimated blood loss, gross total resection rate.

Results Of 634 patients included, 175 underwent surgery with intraoperative navigation and 444 had no intraoperative navigation during surgery. There was no difference in mean age, sex, tumor type, or tumor size between the two groups. Operative time, endoscope use, cerebrospinal fluid diversion, and estimated blood loss were also similar. Two patients showed intraoperative, iatrogenic misdirection in the absence of stereotactic CT navigation (p = 0.99) but similar numbers of patients having navigated and non-navigated surgery returned to the operating room, underwent gross total resection, and showed endocrinological normalization.

Conclusions These results suggest that intraoperative navigation can reduce injury without resulting in increased operative time, estimated blood loss, or reduction in gross total resection.

Keywords

transsphenoidal approach - image guidance - navigation - pituitary adenoma
 

  • References

  • 1 Thomas NWD, Sinclair J. Image-guided neurosurgery: history and current clinical applications. J Med Imaging Radiat Sci 2015; 46: 331-342
    CrossrefPubMedSearch in Google Scholar
  • 2 Pelargos PE, Nagasawa DT, Lagman C. , et al. Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery. J Clin Neurosci 2017; 35: 1-4
    CrossrefPubMedSearch in Google Scholar
  • 3 Gong J, Mohr G, Vézina JL. Endoscopic pituitary surgery with and without image guidance: an experimental comparison. Surg Neurol 2007; 67 (06) 572-578 , discussion 578
    CrossrefPubMedSearch in Google Scholar
  • 4 Lasio G, Ferroli P, Felisati G, Broggi G. Image-guided endoscopic transnasal removal of recurrent pituitary adenomas. Neurosurgery 2002; 51 (01) 132-136 , discussion 136–137
    CrossrefPubMedSearch in Google Scholar
  • 5 Tabaee A, Hsu AK, Shrime MG, Rickert S, Close LG. Quality of life and complications following image-guided endoscopic sinus surgery. Otolaryngol Head Neck Surg 2006; 135 (01) 76-80
    CrossrefPubMedSearch in Google Scholar
  • 6 Guan J, Karsy M, Bisson EF, Couldwell WT. Patient-level factors influencing hospital costs and short-term patient-reported outcomes after transsphenoidal resection of sellar tumors. Neurosurgery 2018; 83 (4): 726-731
    CrossrefPubMedSearch in Google Scholar
  • 7 Karsy M, Brock AA, Guan J, Bisson EF, Couldwell WT. Assessment of cost drivers in transsphenoidal approaches for resection of pituitary tumors using the value-driven outcome database. World Neurosurg 2017; 105: 818-823
    CrossrefPubMedSearch in Google Scholar
  • 8 Eboli P, Shafa B, Mayberg M. Intraoperative computed tomography registration and electromagnetic neuronavigation for transsphenoidal pituitary surgery: accuracy and time effectiveness. J Neurosurg 2011; 114 (02) 329-335
    CrossrefPubMedSearch in Google Scholar
  • 9 Patel SN, Youssef AS, Vale FL, Padhya TA. Re-evaluation of the role of image guidance in minimally invasive pituitary surgery: benefits and outcomes. Comput Aided Surg 2011; 16 (02) 47-53
    CrossrefPubMedSearch in Google Scholar
  • 10 Bohinski RJ, Warnick RE, Gaskill-Shipley MF. , et al. Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery 2001; 49 (05) 1133-1143 , discussion 1143–1144
    PubMedSearch in Google Scholar
  • 11 Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimsky C. Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 2001; 95 (03) 381-390
    CrossrefPubMedSearch in Google Scholar
  • 12 Zaidi HA, De Los Reyes K, Barkhoudarian G. , et al. The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the advanced multimodality image guided operating suite. Neurosurg Focus 2016; 40 (03) E18
    CrossrefPubMedSearch in Google Scholar
  • 13 Elias WJ, Chadduck JB, Alden TD, Laws Jr ER. Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 1999; 45 (02) 271-275 , discussion 275–277
    CrossrefPubMedSearch in Google Scholar
  • 14 Orringer DA, Golby A, Jolesz F. Neuronavigation in the surgical management of brain tumors: current and future trends. Expert Rev Med Devices 2012; 9 (05) 491-500
    CrossrefPubMedSearch in Google Scholar
  • 15 Schirmer CM, Elder JB, Roitberg B, Lobel DA. Virtual reality-based simulation training for ventriculostomy: an evidence-based approach. Neurosurgery 2013; 73 (Suppl. 01) 66-73
    CrossrefPubMedSearch in Google Scholar
  • 16 Yudkowsky R, Luciano C, Banerjee P. , et al. Practice on an augmented reality/haptic simulator and library of virtual brains improves residents' ability to perform a ventriculostomy. Simul Healthc 2013; 8 (01) 25-31
    CrossrefPubMedSearch in Google Scholar